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PubMed1982

Juvenile periodontitis - healing following therapy to control inflammatory and traumatic etiologic components of the disease.

A case of localized juvenile periodontitis with bone loss affecting molars and premolars with advanced destruction around the lower first molars is described. These lesions were associated with areas of excess occlusal trauma. The ramifications of combined therapy aimed at the elimination and control of both the inflammatory and occlusal components of the disease are discussed relative to the successful treatment of this case. A description of the periodontal status of a sibling of the patient has been included. Extensive defects are associated with the anterior teeth and in this case the patient presented with excessive trauma in the anterior region. Considering the localities of the disease and the similarities between the inflammatory components in both cases, a link between occlusal trauma and juvenile periodontitis is discussed.

Adolescent↗
PubMed1982

Regeneration of infrabony periodontal defects in humans after implantation of allogenic demineralized dentin.

Previous studies have suggested that implants of allogenic demineralized dentin might improve bone regeneration and healing in the treatment of infrabony periodontal defects. In order to make a clinical evaluation of this possibility, the material was inserted into 14 infrabony defects in 10 patients undergoing a new attachment operation. Twelve defects in 12 patients served as controls. In half of these cases no grafting material was used and the remaining six defects were filled with autogenous cancellous bone from the jaw. The defects were classified as two-wall and combined three- and two-wall bony defects. Probing from a fix point and periodic identical X-rays were performed before the surgical treatment and 12 months postoperatively. During healing no clinical signs of rejection of the dentin implants were observed, but the soft tissue healing was delayed, probably due to a slow resorption of the dentin implants. After 12 months no statistically significant difference was found between test and control groups regarding the mean coronal displacement of the bottom of the pocket. No conclusive evidence regarding the capacity of allogenic demineralized dentin to induce new connective tissue attachment could be drawn from the present study, but the clinical results, combined with the fact that the dentin implants are time consuming to produce, indicate that this material is not suitable for the treatment of infrabony periodontal defects.

Adult↗
PubMed1983

Clinical and histological characteristics of lyophilized allogenic dura mater in periodontal bony defects in humans.

This clinical and histological study investigated the use of lyophilized, allogenic dura mater (Lyodura) as a periodontal implant material in interdental bony defects (2-wall lesions) in humans. For 23 defects in 8 subjects a modified Widman flap was raised, curettage performed and the defects bridged with the implant. The same procedure, without Lyodura implantation, was performed on 23 contralateral teeth. By a standardized method, involving the use of a removable stent, the following clinical measurements were recorded after 24 and 48 weeks: the probing attachment level, the probing bone level, the probing pocket depth and the labial and interdental gingival recession. For the histological study 5 additional, interdental craters and 5 control defects were treated as in the clinical study. They were block-sectioned after 1, 2, 6, 12 and 24 weeks and processed in the usual manner for routine examination by light and polarization microscopy. From the clinical study it could be concluded that, in absolute values, only the experimental side showed a significant gain in probing attachment level and a greater reduction of the probing pocket depth. In percentage values the labial gingival recession was significantly lower and the bone formation significantly more pronounced on the experimental side. The histological examination showed that the implant remodelled completely without rejection phenomena. It was replaced gradually, after enzymatic breakdown, by the host's own collagen through the action of invading fibroblasts. Bone formation occurred along but never in the implant. The implant material seems to act as a barrier against epithelial downgrowth and infiltration of inflammatory cells.

Adult↗
PubMed1984

Juvenile periodontitis: healing following autogenous iliac marrow graft, long-term evaluation.

A case of juvenile periodontitis treated by autogenous bone grafting is reported. The patient, an 18-year-old female, presented with periodontal lesions around the incisors and the first lower left molar. The first molar was severely affected with bone defects at the mesial aspect and in the furcation region and, for this reason, was selected for grafting. Minced fragments of bone with its marrow, obtained from the patient's iliac crest, were implanted into the diseased periodontium. 1 year after treatment, clinical and radiological inspection revealed the presence of bone. This bone completely filled the furcation area of the tooth but only partially the mesial aspect. There was, also, significant bone fill in the supracrestal region.

Adolescent↗
PubMed1985

Healing after treatment of periodontal intraosseous defects. III. Effect of osseous grafting and citric acid conditioning.

The present study was performed to determine whether the healing of periodontal intraosseous defects could be improved through the combined use of citric acid conditioning of the root surfaces and grafting of autogenous intraoral cancellous bone. 28 proximal defects in 19 patients were treated surgically including acid conditioning of the root surfaces. Another 25 defects in these patients were treated with acid conditioning combined with osseous grafts using the maxillary tuberosity areas as donor sites. Both therapies, e.g., citric acid conditioning alone and acid conditioning combined with osseous grafting resulted in approximately 1 mm gains of probing attachment and probing bone levels. Within the parameters of this study, osseous grafting did not enhance the effect of citric acid conditioning alone. Limited improvement of the treated defects of the present study was obtained in spite of the use of supplementary regenerative techniques.

Adult↗
PubMed1985

Healing after treatment of periodontal intraosseous defects. VI. Factors influencing the healing response.

84 periodontal intraosseous defects treated with mucoperiosteal replaced flap surgery and citric acid root conditioning were used to study the relationships between various defect characteristics and the healing response as expressed by change of probing attachment level, change of probing bone level and residual probing depth. More gains in probing attachment and probing bone levels were observed in deep defects than in shallower lesions. Other defect characteristics showed weak or no correlations to defect fill. The findings of this study seem to indicate that the outcome of treatment of intraosseous defects may be difficult to predict based upon evaluation of defect characteristics.

Adult↗
PubMed1987

Longitudinal quantitative radiodensitometric study of treated and untreated lower molar furcation involvements.

38 first or second lower molars from 16 patients showing furcation involvements of degrees 1 and 2 were treated after motivation and hygiene instruction, either by subgingival curettage, or by the modified Widman surgical procedure or by furcation plasty. The plaque index, the gingival index of inflammation and the depth of interproximal and interradicular pockets were recorded before and up to 1 year after the 3 therapeutical procedures. The above clinical indices were also followed for 2 years in 15 lower molars from 7 untreated patients. A quantitative radiographical analysis of the interradicular bone was performed in all patients, by using superposable identical radiographs and a computer-assisted photodensitometric technique. In the 3 groups of treated patients, the clinical scores were, in general, improved by the 3 therapeutic modalities. In the furcation areas, the plaque index was always higher on the lingual side, whereas the depth of "horizontal" pockets was always greater on the buccal side. Except for the lesions treated by furcation plasty, no change could be noticed clinically in the depths of vertical or horizontal penetration of a periodontal probe in the furcation areas. The quantitative radiographic analysis, however, clearly showed a loss in the first 2 mm of superficial bone during the 2 months following the 3 therapeutical procedures: this loss was followed by a statistically significant recovery and, for the group treated by curettage, even by a net gain during the 6 to 12 months following therapy. The radiographical density of the deeper layer of bone did not change in the group treated by curettage only. It showed a loss in the first 2 months following the 2 surgical procedures but a statistically significant recovery in the months thereafter. As for the group of untreated patients, at the examinations performed initially, 6 months, 1 and 2 years later, the number of plaque-free and non-bleeding sites in the furcation areas was lower on the lingual as compared to the buccal side, whereas the frequency distribution of furcation involvements was similar on both aspects. No significant changes were found in the various clinical parameters throughout the 2 years of the study. On the contrary, a significant loss of average density of the superficial layer of interradicular bone was already measured on the superposable radiographs 6 months after the initial examination and was found to increase thereafter. No changes of radiodensity could be measured for the deeper layer of bone.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1988

Computer-assisted densitometric image analysis in periodontal radiography. A methodological study.

A videobased computer assisted densitometric image analysis (CADIA) system to quantify alveolar bone density changes on standardized dental radiographs was tested. An algorithm was used for grey level correction of a subsequent image to the baseline image. Quantitative information regarding positive and/or negative grey level changes were obtained automatically. Comparison of the ability of CADIA to detect surgically induced bone loss with interpretation of digital subtraction images and conventional radiographic interpretation revealed that CADIA was the most sensitive of the 3 methods, followed by interpretation of digital subtraction images which was considerably more sensitive than conventional radiographic interpretation. CADIA was capable of assessing differences in alveolar bone changes due to periodontal surgery between sites exposed to ostectomy/osteoplasty and control sites and sites exposed to periodontal surgery without ostectomy/osteoplasty. Finally, CADIA was capable of assessing differences in remodeling activity over 4-6 weeks after periodontal surgery between 45 surgical sites and 45 control sites. The system offers an objective method to quantitatively follow alveolar bone density changes over time and appears to be the most sensitive of previously described radiographic interpretation techniques.

Absorptiometry, Photon↗
PubMed1989

Computer-assisted densitometric image analysis (CADIA) for the assessment of alveolar bone density changes in furcations.

The purpose of this study was to test the applicability of computer-assisted densitometric image analysis (CADIA) for the quantitative assessment of alveolar bone density changes in furcations of multirooted teeth. In 21 patients, standardized radiographs were obtained immediately after and at 1, 6 and 12 months after periodontal flap procedures. Digitized images were obtained by means of a video-camera combined with an image processor that was linked to a computer. Quantitative information regarding density changes within windows covering furcation areas was obtained after superimposition and grey-level correction of images to be compared. 1 month after flap reflection, significantly more density loss was obtained in test furcations exposed to periodontal surgery, compared to the density changes in control furcation exposed to scaling and root planing. At 12 months, however, significantly greater increase in density was measured in test furcations compared to the 1-month results. The radiographic data were compared to the clinical parameters. In test furcations, there was a negative correlation of r = -0.52 between the GI and the loss in density at 1 month, and a negative correlation of r = -0.61 between the loss in density at 6 months and the probing attachment level at 12 months. These results indicate that CADIA may give valuable additional diagnostic information regarding alveolar bone density changes in furcations in studies on periodontal therapy.

Alveolar Process↗
PubMed1989

Osseous defect responses to hydroxylapatite grafting versus open flap debridement.

Data from a large number of defects (152) treated with hydroxylapatite (HA) grafts were compared to those from a large number of defects (111) treated by surgical debridement alone (DEBR). Comparison of initial and re-entry surgery measurements showed that both the analysis of relative defect fill and the intrapatient comparisons demonstrated an advantage to the use of HA graft material. 58% of the HA-grafted defects were judged to have a positive (greater than or equal to 50% defect fill) hard tissue response compared to 30% for DEBR. Minimal responses (failures) were 4 times as numerous with DEBR. Similarly, within each patient, HA grafting proved of benefit, particularly regarding hard tissue changes. The use of HA graft materials appears to be of clinical benefit in a majority of defects and a majority of patients.

Adult↗
PubMed1989

Evaluation of gingival bleeding following 4 types of periodontal therapy.

This study evaluated the effects of 4 types of periodontal therapy (coronal scaling (CS), root planning (RP), modified Widman surgery (MW), and flap with osseous resectional surgery (FO] and subsequent maintenance care upon bleeding on probing (BOP). 75 individuals completed split mouth therapy and 2 years of maintenance followup. Data were obtained by 1 calibrated examiner prior to the initiation of therapy, following the hygienic phase and surgical phase of active therapy and yearly during maintenance care. All types of therapy reduced the prevalence of BOP. At the end of 2 years of maintenance therapy, regions greater than 5 mm treated by CS demonstrated a significantly (p less than 0.05) greater prevalence of BOP sites than regions treated by the other modalities. Generally, sites associated with deeper probing depths exhibited a greater tendency to bleed and sites with associated plaque accumulation bled more frequently. RP resulted in a significantly (p less than 0.05) higher % of bleeding sites that stopped following active therapy than did CS. Throughout the study, BOP was extremely dynamic, with 15-88% of sites converting to a new status between any 2 examination periods. This dynamic nature may explain the inability of previous investigations to establish BOP as a reliable predictor of periodontal breakdown.

Alveoloplasty↗
PubMed1990

5-year follow up of periodontal intraosseous defects treated by root planing or flap surgery.

Intraosseous, periodontal defects in 12 subjects initially treated by root planing alone (21 defects) or by flap surgery (21 defects) were monitored during a 5-year postoperative interval. Maintenance therapy during this interval was limited to reinforcement of oral hygiene and tooth polishing every 6 months. No subgingival instrumentation was performed at the defect sites. Longitudinal clinical measurements demonstrated that surgically-treated lesions responded with somewhat more reduction of probing depth and more gain of probing bone level than root-planed lesions. Mean gains of probing attachment level were similar for the 2 treatments. Some relapse of the clinical conditions could be observed towards the end of the 5-year observation interval compared to the results at year 1 and year 2. However, the majority of defects subjected to either treatment showed 60-month recordings of probing attachment and probing bone levels equal to or slightly improved compared to those at baseline. Counts from cultures of subgingival, microbial samples were obtained at 42, 48 and 60 months. No significant difference between the 2 therapies was observed for the investigated groups of micro-organisms.

Adult↗
PubMed1991

Human intrabony lesion responses to debridement, porous hydroxyapatite implants and teflon barrier membranes. 7 histologic case reports.

7 vertical lesions at 7 teeth in 3 adults with severe periodontitis were treated using open surgical debridement, porous hydroxyapatite grafts and placement of a barrier membrane. Roots were notched at both gingival margins and deepest visible calculus. Flaps were sutured coronally and patients were placed on 0.12% chlorohexidine gluconate twice daily for 2 weeks, post-surgery. Patients returned frequently for plaque control until block removal at 16 to 28 weeks post-surgery. 1 additional block was harvested after 28 weeks. The latter site received root planing only and closed by epithelial adhesion. In the 7 experimental sites, clinical responses were uneventful, and gain in clinical closure varied from 1.7 to 5.0 mm (average = 3.6 mm). Histologically, 2 sites exhibited closure by a long junctional epithelium. The remaining 5 sites showed gingival recession to be apical to the calculus notch or the calculus notch to be epithelialized. However, apical to the notch and within the osseous crater, cellular cementum deposition was marked as was increased bone mass. The increase in bone mass was the result of osteogenesis within the surrounding graft particles which often fused with osseous seams of the crater. A functionally-oriented PDL was seen usually at these sites.

Adult↗
PubMed1991

Histologic healing responses in human vertical lesions following the use of osseous allografts and barrier membranes.

4 vertical lesions at 3 teeth in 2 volunteer adults with severe periodontitis were treated by open surgical debridement, osseous allografts and barrier membranes. Roots were notched at both gingival margins and the deepest visible calculus and flaps were sutured coronally. Patients were placed on 0.12% chlorhexidine gluconate 2x daily post-surgery, and blocks were harvested 5 to 6 weeks after surgery. No abnormal clinical responses were noted during the observation period. In the 4 sites, the average preoperative pocket depth was 9.4 mm; the post-operative pocket depth averaged 4.9 mm, recession averaged 0.9 mm and gain in clinical closure averaged 3.6 mm. Histologically, new cementum measured coronally-apically at the treated sites varied from 0.0 mm to 1.7 mm, with an average of 1.1 mm. Osseous remodelling and crestal osteogenesis were seen in association with cementogenesis. The newly deposited cementum showed insertion of functional oriented fibers. New attachment was present within 2 out of 4 calculus notches in this sample.

Adult↗
PubMed1992

Surgical lengthening of the clinical crown.

The aim of the present study was to assess the changes in the periodontal tissue levels as an immediate result of the surgical crown lengthening procedure and over a 6-months healing period. 25 patients ranging between 20 to 81 years of age were included in the study. A total of 85 teeth (43 test and 42 control teeth not exposed to surgery) were evaluated over 6 months. After initial therapy, the indication for crown lengthening comprised need for increased retention and accessibility to deep subgingival preparation margins hampering impression taking. During surgery, the alveolar crest was reduced, thereby creating a distance of 3 mm to the future reconstruction margin. The results of this study demonstrated that the mean probable changes in the levels of the periodontal tissues from those defined after surgery were minimal, resulting in changes comparable to the shifts observed at control teeth not exposed to any surgical procedures. Frequency analysis of the number of sites with dislocation of the free gingival margin demonstrated that 12% of the sites with crown lengthening procedure showed 2-4 mm recession of the free gingival margin between 6 weeks and 6 months postoperatively. In esthetically critical, visible areas of the dentition, recessions must be closely observed in the healing period after surgical crown lengthening, when prosthetic reconstructions are planned on such teeth.

Adult↗
PubMed1995

Clinical and microbiological changes associated with an altered subgingival environment induced by periodontal pocket reduction.

The purpose of the present investigation was to study the effect of an altered subgingival environment, induced by changing the local soft tissue morphology, i.e., pocket depth reduction, on the subgingival microbiota and the clinical conditions. 7 patients aged 30-60 years with generalized marginal periodontitis were selected. Patients were instructed in proper oral hygiene and all teeth were cleaned supragingivally. Mucoperiosteal flaps were raised and the bone re-contoured to eliminate angular bony defects. While the control teeth were carefully debrided and thoroughly root planed, no root instrumentation was performed on the test teeth. Calculus deposits visible to the naked eye were only chipped-off with the tip of a scaler. The flaps were apically repositioned and sutured at the level of the bone crest. Clinical parameters showed a similar pattern of response in the test and control sites over a one year observation period post therapy. Probing depths and probing attachment levels were significantly reduced one month after surgery and remained at a lower level. A significant decrease was also noted for total anaerobic viable bacterial counts. The proportion of the Gram-negative anaerobic rods decreased significantly in both groups. P. gingivalis, Fusobacterium sp., C rectus were detected significantly less often after treatment in both groups. Capnocytophaga and A. odontolyticus, on the other hand, were more frequently isolated after therapy. These findings corroborate the concept that the reduction of selected subgingival microorganisms is the key element for the success of periodontal therapy, rather than the removal of tooth substance and mineralized deposits by root instrumentation.

Actinomyces↗
PubMed1996

Effect of pretreatment with ketorolac tromethamine on post-operative pain following periodontal surgery.

A double-blind, randomized, single-dose clinical trial to evaluate the analgesic efficacy of preoperative ketorolac tromethamine administration on periodontal postoperative pain was designed. One group received 20 mg ketorolac immediately before periodontal flap surgery, and the other group received placebo. Naproxen sodium was allowed postoperatively as rescue medication. The visual analog scale was used to estimate pain. Postoperative pain was assessed hourly for the first 10 h on the day of surgery, and 4 x daily on the 1st and 2nd postsurgical days. Timing and dose of rescue analgesic remedication were also recorded. Results indicated that preoperative treatment with ketorolac significantly reduced initial pain intensity and delayed the onset of postoperative pain as compared to placebo. Incidence and amount of naproxen consumption was similarly small in both ketorolac- and placebo-treated groups. No adverse reactions related to preoperative medication were observed.

Adult↗
PubMed1998

Long-term effects of root-resective therapy in furcation-involved molars. A 10-year longitudinal study.

The present investigation was designed to evaluate the long-term effect of root-resective therapy in the treatment of furcation-involved molars. The patient sample included 72 patients, 21-62 years of age, who presented periodontal lesions in the posteriors segments of the mouth including furcation involvement of various degrees. After an initial examination, each patient was subjected to a series of full-mouth scaling and root planing. They were recalled 1-3 months later for a presurgical examination and subsequently underwent the corrective phase of therapy. During the surgical procedure, the furcation-involved teeth were subjected to root-resective therapy in conjunction with osseous recontouring and apically positioned flaps (test sites). A surgical procedure identical to the test procedure was performed in the non-furcation-involved teeth (control sites) with the exception of the root resection. At the completion of the active phase of treatment, 175 test and 175 control sites were available for the study. After a period of 6 months of healing and plaque control supervision following surgical procedures, the patients were recalled for a baseline examination. They were then enrolled in a maintenance program including professional tooth cleaning every 26 months. The patients were re-examined 3, 5 and 10 years post-operatively. The results of the assessments demonstrated that the survival rate, during the 10-year period of observation, reached 93% at test and 99% at control sites. The positive treatment outcome at the root-resected, furcation-involved teeth as well as at non-furcation-involved teeth was probably the consequence of the reestablishment of a tissue morphology favorable for oral hygiene and careful plaque control by the patients.

Adult↗